McKee Diane, Fletcher Jason
Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, USA.
J Health Care Poor Underserved. 2006 Nov;17(4):759-74. doi: 10.1353/hpu.2006.0131.
Adolescent girls face unique challenges in health care utilization, which can result in unmet needs. We sought to describe settings of usual care and primary care use, and to identify predictors of foregone care and experience of confidential care in a primarily racial/ethnic minority low-income sample. We conducted an anonymous computer-assisted self-administered survey of 9th-12th grade girls (n=819) in three Bronx public high schools, the majority of whom were Hispanic (69.8%) and Black (21.4%). Most (80%) reported having a usual source of care. Of these, 77.2% had a regular doctor. Those least likely to have a usual source of care were non-U.S. born girls (73.1% vs. 83.1%) and less acculturated girls. Predictors of foregone care in the last year include being sexually active, poor family social support, and low self esteem. Predictors of access to confidential care at last visit were age, self-efficacy for confidential care, having a regular doctor, setting of care, and having had a recent physical exam. Many urban adolescent girls, especially non-U.S. born girls, lack a usual source of care and regular health care provider. Continued attention to reducing both financial and non-financial barriers to care is required to ensure access to and quality of care for diverse populations.
青春期女孩在医疗保健利用方面面临独特挑战，这可能导致需求未得到满足。我们试图描述常规护理和初级护理的使用情况，并在主要为少数族裔低收入样本中确定放弃护理的预测因素以及获得保密护理的经历。我们对布朗克斯区三所公立高中的9至12年级女生（n = 819）进行了一项匿名的计算机辅助自我管理调查，其中大多数是西班牙裔（69.8%）和黑人（21.4%）。大多数（80%）报告有常规护理来源。其中，77.2%有固定医生。最不可能有常规护理来源的是在美国以外出生的女孩（73.1%对83.1%）和文化适应程度较低的女孩。去年放弃护理的预测因素包括性活跃、家庭社会支持差和自尊心低。上次就诊时获得保密护理的预测因素是年龄、保密护理的自我效能感、有固定医生、护理环境以及最近进行过体检。许多城市青春期女孩，尤其是在美国以外出生的女孩，缺乏常规护理来源和固定的医疗保健提供者。需要持续关注减少护理的经济和非经济障碍，以确保不同人群能够获得护理并保证护理质量。
